Over the past few months, THT Executive Board has been involved in various conversations and workshops to prepare for the implementation of the North East London Integrated Care System (ICS), which went live on 1 July. We will meet for the first time as the formal Place committee in September. Our June Board meeting was a workshop which focussed on exploring how we will need to operate differently in the new ICS, in relation to both service transformation and assurance. THT is in a strong position, with well-established partnership structures, collaborative and candid relationships rooted in trust, and an existing THT plan, user-led outcomes framework and recently reset Place priorities that can be built on to align with NEL’s four priorities: babies, children and young people; long-term conditions; mental health; workforce. As we move into the committee role and adapt our governance, the Board was clear we need a balance between performance to meet NEL’s requirements of Place and a focus on local issues and priorities which maintains a strong user and expert voice at its heart.
In July we held a second workshop with Charlotte Pomery, NEL’s new Chief Participation and Place Officer and Chris Cotton, the Director of Integrated System Transition. Charlotte was very explicit that she sees Place as the “engine room” but there will be tensions between NEL, Place and the provider collaboratives that need to be worked through. NHS England’s expectation is for Place to be where delivery happens, with a focus on immediate system pressures and integrated neighbourhood teams. An ICS strategy needs to be in place by end of December and NEL is currently trying to model financial delegation to Place. The workshop reviewed best practice around seven ingredients for a successful Place, reflecting on THT’s strengths and gaps in relation to each. The ingredients are: strong system leadership; a Place team including the Lead, Clinical Director and Delivery Director; people participation; vision, strategy and plan; insight – both quantitative and qualitative; workforce; governance and accountability.
The regular July Board had an engagement spotlight on dementia, hearing from Paul, a carer, and John, a staff member from Russia Lane day centre. During the pandemic, the service adapted to provide outreach and gained a better insight into the challenges families face. Paul described it as a day service plus a “comfort blanket”, providing invaluable respite during the day to carers but also ongoing persistence with navigating barriers in the health, care and wider social support systems. We were struck by the personal, celebratory and inclusive approach – not just a day centre but planned trips which are active and varied, “memory lane” walks around people’s childhood neighbourhoods, extra support and extended respite hours put in place for families following a bereavement of one elderly parent. John also flagged concerns that referrals happen too late and often when families are already at crisis point in trying to support their loved one with dementia. Other items in July were: the Healthy Building Programme for asset and infrastructure management across NEL; changes to the enhanced access service in primary care; allocation of section 256 and section 75 pooled funds primarily to support demand management, increase efficiencies and for integrated discharge arrangements and care packages. We also approved THT’s anti-racism action plan, including investment of £100k into anti-racism education for THT leaders, managers and HR professionals. NEL has also awarded THT £900k for a local equity quality improvement programme and specific projects, including one to embed and support Black, Asian and Minority Ethnic leaders across THT.
August’s Board had an engagement spotlight on ELFT’s advance care planning team, which aims to avoid unnecessary hospital admissions in the final year of life. Following a referral, the team visits, understands and supports the individual’s wishes such as being able to die at home with their family around them. It was a really impressive multi-disciplinary approach involving different health and care professionals based on individual needs, and also offering tailored referrals and support for families. The Board were full of praise for this service which has very rapidly been able to support people to die well in a place of choice.
We also had our quarterly performance update, which reported on the ongoing high waiting lists at the Royal London (common across NEL) and 30% increase in education, health and care plans due to a spike in unaccompanied asylum-seeking children in the borough. We agreed to focus on the increased demand across the whole system at a future Board meeting. NEL presented on their new system quality framework, which will include indicators that it requires the whole system working together to improve and aims to shift from transactional measures to a focus on people and causes. We had updates on the local public mental health and trauma-informed care programme, s256 pooled funds, and next steps on the equity quality improvement programme.
I’m looking forward to September, which will be our first Board meeting operating as a Place committee and also the THT Staff Integrated Care Awards – a chance to celebrate so much individual, team and system-wide good practice!